title: Outcomes of cardiac transplantation in highly sensitized pediatric patients.
abstract: Despite aggressive immunosuppressive therapy, pediatric orthotopic heart transplant (OHT) candidates with elevated pre-transplant panel reactive antibody (PRA) carry an increased risk of rejection and early graft failure following transplantation. This study has aimed to more specifically evaluate the outcomes of transplant candidates stratified by PRA values. Records of pediatric patients listed for OHT between April 2004 and July 2008 were reviewed (n = 101). Survival analysis was performed comparing patients with PRA < 25 to those with PRA > 25, as well as patients with PRA < 80 and PRA > 80. Patients with PRA > 25 had decreased survival compared with those with PRA < 25 after listing (P = 0.004). There was an even greater difference in survival between patients with PRA > 80 and those with PRA < 80 (P = 0.002). Similar analyses for the patients who underwent successful transplantation showed no significant difference in post-transplant survival between patients with a pre-transplant PRA > 25 and those with PRA < 25 (P = 0.23). A difference approaching significance was noted for patients with PRA > 80 compared with PRA < 80 (P = 0.066). Patients with significantly elevated pre-transplant PRAs at the time of listing have a significantly worse outcome compared to those with moderately increased PRA values or non-sensitized patients. Further study is necessary to guide physician and family treatment decisions at the time of listing.
authors.affiliation: Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, B2-427 MDCC, 10833 Le Conte Ave, Los Angeles, CA 90095-1743, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Scott
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Williams
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Levi
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004699:Endocardium / Q000276:immunology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D006085:Graft Survival / Q000276:immunology; D006330:Heart Defects, Congenital / Q000276:immunology / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D000949:Histocompatibility Antigens Class II / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D009206:Myocardium / Q000276:immunology / Q000473:pathology; D010956:Plasmapheresis; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult
chemical_list: D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies